The New Health Dialogue

"Who said it would be easy?" That headline on the Boston Globe's editorial about the Massachusetts health care for all initiative is as wise as it is simple. We often mutter something similar ourselves when we look ahead to the enormous task of fixing the whole country's health care: "If it were easy, we'd have done it already."

We have naturally watched with interest as Massachusetts lawmakers and officials work to close the fiscal gaps (estimated at about $100 million) and develop accurate assessments of future demand as they strive to make sure that everyone in the state has health insurance. The Globe didn't hone in on the financial details today, focusing on the big picture. Although Massachusetts had a relatively low uninsured rate before the reform bill was enacted two years ago this week, it is a high-cost state and enrollment in subsidized insurance plans has been much higher than expected. And it is nearly impossible for a state to fix all the problems on their own, particularly how we pay for and deliver health care, without a systemic nationwide approach. (Hear that Washington?)

But Massachusetts, for all its challenges, has blazed the trail. "While the success of this initiative is not assured, Massachusetts should be proud of accomplishing so much, so quickly," the Globe wrote. According to the editorial, at least 342,000 people had enrolled in insurance plans as of the start of this year, and two in three of them are being subsidized because they are just above the poverty line.

Reform didn't happen because politicians finally decided the time was right (although of course it would not have happened without them). Reform happened because a coalition, both broad and deep, demanded it. It included businesses, health insurers, hospitals, unions, healthcare advocates, and political leaders. "They now need to figure out ways to control costs, maintain quality, and get new money into the system when absolutely necessary," the Globe said, calling on the coalition to "reenergize" itself to preserve its gains and sustain them into the future. We've got our fingers crossed.